Global Health Hub: news and blogosphere aggregator » Politicshttp://www.globalhealthhub.org
Keeping up with global health & development news, blogosphere, forums, events, jobs and moreSun, 02 Aug 2015 12:17:00 +0000en-UShourly1Ambitious new U.S. plan may put hundreds of thousands on MDR-TB treatmenthttp://www.globalhealthhub.org/2015/07/24/ambitious-new-u-s-plan-may-put-hundreds-of-thousands-on-mdr-tb-treatment/
http://www.globalhealthhub.org/2015/07/24/ambitious-new-u-s-plan-may-put-hundreds-of-thousands-on-mdr-tb-treatment/#commentsFri, 24 Jul 2015 18:00:00 +0000http://www.globalhealthhub.org/?p=151277Categories: Research and Development, TB, U.S. Policy and FundingThe United States plans to place 360,000 multidrug-resistant tuberculosis patients globally on treatment over the next five years, as part of a national tuberculosis action plan currently under draft. The plan – which is due to be submitted to the White House in September – aims to promote universal MDR-TB treatment, accelerate basic TB research, […](Read more...)

]]>Categories: Research and Development, TB, U.S. Policy and FundingThe United States plans to place 360,000 multidrug-resistant tuberculosis patients globally on treatment over the next five years, as part of a national tuberculosis action plan currently under draft. The plan – which is due to be submitted to the White House in September – aims to promote universal MDR-TB treatment, accelerate basic TB research, […](Read more…)

]]>http://www.globalhealthhub.org/2015/07/24/ambitious-new-u-s-plan-may-put-hundreds-of-thousands-on-mdr-tb-treatment/feed/0Healthcare In Danger: what happens when it all goes wrong?http://www.globalhealthhub.org/2015/06/24/healthcare-in-danger-what-happens-when-it-all-goes-wrong/
http://www.globalhealthhub.org/2015/06/24/healthcare-in-danger-what-happens-when-it-all-goes-wrong/#commentsWed, 24 Jun 2015 18:54:00 +0000http://www.globalhealthhub.org/2015/06/24/healthcare-in-danger-what-happens-when-it-all-goes-wrong/This week on PLOS Translational Global Health, emergency physician and humanitarian & global health doctor, Jenny Jamieson, writes about some of the tacit dangers of delivering healthcare in low-resource settings. As healthcare workers, some of us travel to resource-limited settings to deliver care where needs are the greatest. Due to various factors, which range from economic inequality among citizens, political instability, natural disasters, conflict or warfare, many of these places are also some of the most dangerous. As a result, healthcare workers can find themselves working side-by-side to crime; and even becoming the target of directed threats or violence. Those who are willing to put themselves on the front line in order to help others, can themselves end up being actively targeted

This week on PLOS Translational Global Health, emergency physician and humanitarian & global health doctor, Jenny Jamieson, writes about some of the tacit dangers of delivering healthcare in low-resource settings. As healthcare workers, some of us travel to resource-limited settings to deliver care where needs are the greatest. Due to various factors, which range from economic inequality among citizens, political instability, natural disasters, conflict or warfare, many of these places are also some of the most dangerous. As a result, healthcare workers can find themselves working side-by-side to crime; and even becoming the target of directed threats or violence. Those who are willing to put themselves on the front line in order to help others, can themselves end up being actively targeted

]]>The White House: G7 Leaders’ Declaration The declaration describes several topics discussed by world leaders at the recent G7 summit in Germany, including the global economy and women’s entrepreneurship; global politics and security; Ebola, antimicrobial resistance, and neglected tropical diseases; climate change and the environment; and the sustainable development agenda (6/8). The White House: Annex…More

]]>http://www.globalhealthhub.org/2015/06/09/white-house-publishes-several-documents-related-to-g7-summit-discussions/feed/0Emerging doctors call for action on global epidemic: non-communicable diseasehttp://www.globalhealthhub.org/2015/05/12/emerging-doctors-call-for-action-on-global-epidemic-non-communicable-disease/
http://www.globalhealthhub.org/2015/05/12/emerging-doctors-call-for-action-on-global-epidemic-non-communicable-disease/#commentsTue, 12 May 2015 11:23:00 +0000http://www.globalhealthhub.org/2015/05/12/emerging-doctors-call-for-action-on-global-epidemic-non-communicable-disease/This week, special guest-bloggers and Australian doctors-in-training, Rebecca Kelly and Tim Martin of the Australian Medical Students’ Association, call for greater focus, discussion and action on the world’s leading causes of death. In March this year, the Australian government released the 2015 Intergenerational report revealing a prediction of the economic and social trends over the next 40 years. There’s some fantastic news; children born in the middle of this century are projected to live greater than 95 years. Importantly, this increase in life expectancy will involve an improved quality of life and Australians will be more prosperous in real terms. However, the report comes with a warning.

This week, special guest-bloggers and Australian doctors-in-training, Rebecca Kelly and Tim Martin of the Australian Medical Students’ Association, call for greater focus, discussion and action on the world’s leading causes of death. In March this year, the Australian government released the 2015 Intergenerational report revealing a prediction of the economic and social trends over the next 40 years. There’s some fantastic news; children born in the middle of this century are projected to live greater than 95 years. Importantly, this increase in life expectancy will involve an improved quality of life and Australians will be more prosperous in real terms. However, the report comes with a warning.

]]>http://www.globalhealthhub.org/2015/05/12/emerging-doctors-call-for-action-on-global-epidemic-non-communicable-disease/feed/0It’s time we had that talk.http://www.globalhealthhub.org/2015/04/22/its-time-we-had-that-talk/
http://www.globalhealthhub.org/2015/04/22/its-time-we-had-that-talk/#commentsThu, 23 Apr 2015 05:28:00 +0000http://www.globalhealthhub.org/2015/04/22/its-time-we-had-that-talk/This week, Dr Alessandro Demaio writes from his home country of Australia. A ‘downunder’ perspective with a global relevance – he asks why we aren’t talking more, about the challenges we all face together, and sets you a challenge. There are very few things that keep me awake at night, these days. I manage to sleep even with the growing burden of obesity around us and the nonsensical insistence in our societal and political rhetoric that despite two-thirds of us being now affected in Australia (combined with overweightedness), it is still pushed as a problem born in individual laziness and ignorance. Blind to the broken system we inhabit

This week, Dr Alessandro Demaio writes from his home country of Australia. A ‘downunder’ perspective with a global relevance – he asks why we aren’t talking more, about the challenges we all face together, and sets you a challenge. There are very few things that keep me awake at night, these days. I manage to sleep even with the growing burden of obesity around us and the nonsensical insistence in our societal and political rhetoric that despite two-thirds of us being now affected in Australia (combined with overweightedness), it is still pushed as a problem born in individual laziness and ignorance. Blind to the broken system we inhabit

]]>http://www.globalhealthhub.org/2015/04/22/its-time-we-had-that-talk/feed/0How Well Are States Respecting the Health of Undocumented People?http://www.globalhealthhub.org/2015/04/22/how-well-are-states-respecting-the-health-of-undocumented-people/
http://www.globalhealthhub.org/2015/04/22/how-well-are-states-respecting-the-health-of-undocumented-people/#commentsWed, 22 Apr 2015 16:34:21 +0000http://www.globalhealthhub.org/?p=147358 A new report released by the University of California Global Health Institute and the UCLA Blum Center on Poverty and Health in Latin America Read More

]]>http://www.globalhealthhub.org/2015/04/22/how-well-are-states-respecting-the-health-of-undocumented-people/feed/0Obama Administration Announces Plan To Address Antibiotic Drug Resistancehttp://www.globalhealthhub.org/2015/03/30/obama-administration-announces-plan-to-address-antibiotic-drug-resistance/
http://www.globalhealthhub.org/2015/03/30/obama-administration-announces-plan-to-address-antibiotic-drug-resistance/#commentsTue, 31 Mar 2015 01:16:00 +0000http://www.globalhealthhub.org/2015/03/30/obama-administration-announces-plan-to-address-antibiotic-drug-resistance/The Hill: Obama unveils $1.2B plan to tackle drug-resistant bacteria “President Obama on Friday announced a long-awaited national plan to combat the growing threat of antibiotic-resistant bacteria, which he called one of the world’s ‘most pressing’ public health crises. It is the first White House plan to specifically address antibiotic resistance, which causes 2 million…More

WASHINGTON — President Obama on Friday urged Congress to double the funding to confront the danger of antibiotic-resistant bacteria, calling it a major public health issue that, if left unchecked, would “cause tens of thousands of deaths, millions of illnesses.”

The administration also issued a new plan for attacking the problem, part of a national strategy that Mr. Obama laid out in an executive order in September. The plan calls for improved surveillance of outbreaks, better diagnostic tests and new research on alternative drugs. It also urges government agencies to bolster systems to track the consumption of antibiotics and to reduce inappropriate use in people and animals.

“We take antibiotics for granted for a lot of illnesses that can be deadly and debilitating,” Mr. Obama said after meeting at the White House with members of his council on science and technology. “Part of the solution is not just finding replacements for traditional antibiotics, but also making sure we use antibiotics properly.”

In the United States, any cluster of tuberculosis cases makes headlines, no matter how small the numbers. For example, local health authorities recently issued a warning to medical providers after 15 residents of a New York City neighborhood contracted tuberculosis over a two-year period — and the tabloids promptly hyped the news.

When 78 people in Los Angeles contracted tuberculosis between 2007-2013, local health authorities asked for federal help in controlling the outbreak, which then became national news.

]]>http://www.globalhealthhub.org/2015/03/27/u-s-must-increase-capacity-for-global-health-rd-anticipate-global-disease-threats/feed/0Kaiser Family Foundation Releases Fact Sheet On U.S. Govt & Global TBhttp://www.globalhealthhub.org/2015/03/25/kaiser-family-foundation-releases-updated-fact-sheet-on-u-s-government-and-global-tb/
http://www.globalhealthhub.org/2015/03/25/kaiser-family-foundation-releases-updated-fact-sheet-on-u-s-government-and-global-tb/#commentsWed, 25 Mar 2015 21:47:00 +0000http://www.globalhealthhub.org/2015/03/25/kaiser-family-foundation-releases-updated-fact-sheet-on-u-s-government-and-global-tb/Kaiser Family Foundation: The U.S. Government and Global Tuberculosis This updated fact sheet discusses U.S. government global TB efforts and funding, global statistics related to the disease, and international goals to control and treat TB (3/20).

]]>Kaiser Family Foundation: The U.S. Government and Global Tuberculosis

This updated fact sheet discusses U.S. government global TB efforts and funding, global statistics related to the disease, and international goals to control and treat TB (3/20).

Tuberculosis (TB), an infectious disease caused by bacteria, is one of the world’s major causes of illness and death, despite being preventable and often curable. Approximately one-third of the world’s population carries the TB bacteria, about 9 million of whom develop “active” TB each year, which can be spread to others (“latent TB” disease cannot be spread, see box below). TB is found in every country in the world, though the majority of TB cases are concentrated in developing countries.1

In the 1990s and early 2000s, concern about rising incidence in some areas, new outbreaks, TB/HIV co-infection, and the emergence of TB drug resistance prompted key global health actors and governments, including the U.S. government (USG), to make preserving and advancing the progress of global efforts against TB a priority.2Particularly in the past decade, global efforts to address TB have become more prominent, and global TB incidence, prevalence, and mortality rates have fallen.3 Still, as deadlines for reaching key global TB control goals draw near, significant challenges remain.

USG involvement in global TB efforts was relatively limited until the late 1990s. Since that time, its efforts to address TB have grown, and the USG is now one of the largest donors to global TB control through its bilateral and multilateral activities.7 The passage of the legislation that launched the President’s Emergency Plan for AIDS Relief (PEPFAR, the expanded USG response to global AIDS) in 2003 placed a heightened priority on U.S. global TB efforts that continues to this day.

]]>http://www.globalhealthhub.org/2015/03/25/kaiser-family-foundation-releases-updated-fact-sheet-on-u-s-government-and-global-tb/feed/0HIV Exceptionalism in Sierra Leone: An Interview with Adia Bentonhttp://www.globalhealthhub.org/2015/03/23/hiv-exceptionalism-in-sierra-leone-an-interview-with-adia-benton/
http://www.globalhealthhub.org/2015/03/23/hiv-exceptionalism-in-sierra-leone-an-interview-with-adia-benton/#commentsMon, 23 Mar 2015 14:32:14 +0000http://www.globalhealthhub.org/?p=145879 I recently read the book HIV Exceptionalism: Development through Disease in Sierra Leone, by Adia Benton, a medical anthropologist and Assistant Professor at Brown Read More

I recently read the book HIV Exceptionalism: Development through Disease in Sierra Leone, by Adia Benton, a medical anthropologist and Assistant Professor at Brown University. Benton provides an ethnographic account of why HIV/AIDS prevention and treatment programs proliferated in Sierra Leone in the 2000s, despite the country’s fairly low HIV prevalence rate (~1%) in comparison to other countries of sub-Saharan Africa. In Sierra Leone’s capital Freetown, the primary site of Benton’s fieldwork, thirty NGOs were operating internationally-funded HIV/AIDS prevention and care programs for a population of about one million people. The book explores how the logic of HIV exceptionalism—the idea that HIV/AIDS is an exceptional disease requiring an exceptional response—affects how these programs operate on the ground, how they are experienced by locals, and what they do to local health systems.

The book is a short and engaging read, and I’d recommend it to anyone with an interest in HIV/AIDS, development, post-conflict nations, and global health, particularly in sub-Saharan Africa. The following is part of a conversation that I had with Benton about the book.

Benton holds an MPH from Emory University and a PhD in anthropology from Harvard University. She has worked in the fields of gender-based violence, post-conflict development, child health, and HIV/AIDS in a variety of contexts including Sierra Leone, Nigeria, Kenya, Indonesia, and Nepal.

Your book is titled “HIV exceptionalism.” What is HIV exceptionalism?

HIV exceptionalism is actually a term coined in the 1990s. It is a term that is widely used to refer to the fact that HIV/AIDS is an exceptional disease requiring an exceptional response. What that means, in effect, is that whatever seems to work in terms of social, political, economic, and health interventions can be applied to HIV as a problem. It means thinking of HIV as something that crosses many sectors—for example, gender, health, economics, and politics. And the way that HIV exceptionalism manifests itself in bureaucratic institutions is that there are staff, funding, programs, etc., that are primarily devoted to HIV as a public health problem, and as a social problem.

Your book is about your ethnographic field research in Sierra Leone, where HIV actually isn’t all that prevalent compared to other sub-Saharan African countries. But there is still a huge HIV industry serving the country. How did that come about, and how does that industry relate to this concept of HIV exceptionalism?

To some extent, there were specific Sierra Leonean factors related to that. There was an 11-year civil war period, during which there were high levels of sexual violence, amputations, and degraded health systems. The assumption at the time, or at least in the early 2000s, was that war generally increases HIV incidence and prevalence, and that HIV would be a major problem in Sierra Leone. So HIV programs were a natural kind of intervention at the time. There’s that piece, but there’s also that NGOs that were working in Sierra Leone in general were already doing HIV work worldwide, and particularly in sub-Saharan Africa. And so Sierra Leone was perceived to be in need not only because of the war, but also because that was the sort of general feeling in the aid community: that we should be addressing HIV, in terms of prevention and treatment, in a sub-Saharan African country.

A related concept—also part of your book title—is the idea that development occurs through disease in global health.

There is an interesting relationship between development and HIV, which is that HIV is seen to hamper development, but also that development interventions are a means through which one can address HIV prevalence, and that in part owes to this idea of HIV as exceptional. HIV often affects the most productive members of society, and if you think of productivity in terms of what kind of labor people can do, and how you can exploit that labor and generate income out of it, HIV would necessarily pose a threat to development, right? And the development industry and development programs are not only focused on creating economically productive bodies and populations, but they also see health as central to that project more generally. And so thinking about HIV in relation to development is something that’s a part of the Sierra Leonean state-building process and post-conflict rebuilding process.

What are some of the results that you seen of treating HIV as exceptional disease in Sierra Leone?

What ends up happening is that many people buy into that notion of HIV as exceptional, but they do so in a way that shapes whether and how other diseases matter. One of the negative effects of HIV exceptionalism has been building up and separating HIV capacity at the expense of other pressing issues. And this wasn’t the intention. The intention, in responding to HIV, was in part to also develop health systems—to do it by proxy. Because the ideal is that if you build HIV capacity to deal with HIV, you then have created capacity to deal with a bunch of other things. For example, you create surgical capacity to handle infection control, and all of that stuff would then feed into a larger system. But that’s not what happened. A lot of this has to do with funding mechanisms and donor priorities.

Then there is also the day-to-day reality of HIV exceptionalism. There’s a lot of work done, particularly in support and care programs, to develop HIV positive people. These kinds of programs demand certain kinds of people. Basically, there are certain kinds of techniques, certain kinds of things that HIV programs do. They require that people demonstrate their vulnerability, in a variety of ways, but they also have to show that they are self-sufficient. In many ways, HIV programs place certain kinds of demands on people who are HIV-positive. Because the people who use HIV programs feel some kind of pressure, an undue stress, to behave as the program asks them to—to disclose their HIV status, to show their vulnerability, to show their self-sufficiency. And there are many stakes involved. People who actually show they are both vulnerable and self-sufficient rise up through the ranks, in terms of access to certain kinds of goods, certain kinds of opportunities, in ways that people who aren’t really good at doing it will not be able to. It’s kind of a paradox. Being HIV-positive produces paradoxical forms of privilege. You shouldn’t have to be sick with HIV to receive good treatment, to get targeted care, to gain access to certain kinds of goods and services.

Do you see these dynamics—of demanding a certain type of behavior from program beneficiaries—as empowering, disempowering, somewhere in between?

I think it depends largely on the resources that the person brings to the table. Those people who are more eloquent, people who are more articulate, who have certain political or personal agendas, are very empowered by this. People who aren’t really buying into the agenda of fully embracing an HIV positive identity, I think it’s much more difficult for them. Because they end up navigating different resources, navigating a difficult terrain for themselves. So I think it can be either or both, depending on the characteristics of the person, the person’s social positioning, and his or her relationship to the disease.

How can programs avoid burdening beneficiaries with these sorts of responsibilities, and positioning them in such a way that they need to disclose their HIV status to get resources? What suggestions would you have for people on the ground engaged in this sort of work?

It’s going to sound a little bit old-fashioned, but one of the things that was always really promising was primary health care. You have to wonder how or whether HIV programs can actually be pulled back into a comprehensive care agenda. I think this might be more difficult in high prevalence places, but there’s evidence from places like Malawi and Mozambique—even in those high prevalence places—that HIV doesn’t need to stand alone. Rather, the capacity can be developed through HIV programs. So for example, HIV lab capacity can create other kinds of lab capacity. Support groups and care for people have chronic illnesses might benefit from the lessons learned from HIV. I think it’s time for us to think about how to better integrate HIV into more comprehensive care systems—more comprehensive and functional health systems.

Now that’s obviously much more difficult than it sounds. But I think that’s ultimately it. I think there are ways in which the institutions and structures that are part of HIV programs could actually be brought into the fold of health systems and into comprehensive care. So a support group can be for chronic illnesses and conditions, like diabetes, or hypertension, all these other things—not just HIV. I just think it’s a shame that for all of the really wonderful work that HIV programs have been doing and have set out to do, that they’ve also created this bifurcation, this wildly divergent set of outcomes across the world.

Do you feel like this dynamic of exceptionalism is apparent in any other global health programs, projects, or ideas?

I’ve been thinking about this a lot, especially because historians always ask me this question—for example, what about syphilis at the turn-of-the-century? Or polio? Or smallpox? We are in an age of different types of technologies. HIV might exceed what we have seen in the past. I think it might’ve been a perfect storm that created HIV exceptionalism. At the time of its discovery, we reached a point at which biomedicine had seemingly overcome and triumphed and could cure most ills, or at least treat lots of them. And so HIV seemed different, in that it attacked people who are of a certain age, of a certain class, and in a certain place, where activism coalesced with a health condition in a way that didn’t happen with say, various forms of cancer or syphilis. HIV exceptionalism dovetailed with activism and shaped institutions in ways that have never been seen before. For example, ACT UP was able to change the FDA’s process for approving drugs. Big pharma was challenged on drug pricing and patents. When has that ever happened? We have a conservative administration that gave millions and millions of dollars for a disease once associated with ‘immorality’ —I’m talking about the Bush administration—out of humanitarian impulse. We’ve never seen anything like that before. We’ve seen disease eradication programs, like smallpox, polio, but I think there’s another layer here that actually makes it exceptional. There’s a reason that Jim Curran, the Dean of the Public Health School at Emory, and one of the original epidemiologists working on AIDS, said, “AIDS is different, stupid!” Because it was. But now it’s not. And in fact, I think he also said that recently in a public discussion among ethicists.

I don’t think there’s anything else like HIV, but even HIV is not like it was before. There has to be some kind of shift in how people conceive of it. One of the points that I try to make the book is that because of the ways in which these programs have tried to inculcate, or create, or foster certain kinds of subjective experiences around HIV identity, it’s going to be more difficult than we ever expected to shift this way of thinking about HIV.

Do you think that there is a logic of exceptionalism operating around the Ebola epidemic? Do you think similar ideas are playing out?

Some of my friends said this about Ebola recently. I hate to place exceptionalism as a label on this. But Ebola did overtake everything else. At some point, by late August 2014, it was the biggest killer in Liberia. It was actually taking over everything else, if you were to look at data from previous years of what causes deaths in Liberia. Rightfully so, it overshadowed other aspects of health care, but at a detriment or loss for other things: like, ironically, HIV treatment and care; obstetric emergencies; general health care. I think Ebola was also an opportunity. And I hate using the word opportunity to talk about Ebola. But I think it was also an opportunity for people to step back and say hey, this is what happens when you have fragmented health systems, when you don’t have enough health workers. It was one of those things that revealed the limitations of how health work has been done, especially global health in these places over the past 10 or 15 years. I’m not sure what this realization is actually going to do, unless there is a concerted and serious effort to fundamentally change how health systems strengthening is done –because you’re not going to build health systems in just a few years. Health aid isn’t structured in such a way to fundamentally change how health care is done. We have international NGOs doing a good share of health programming. Not enough health workers are being trained, the facilities aren’t sufficient in number, they aren’t adequately stocked or staffed, and health worker compensation is disparate depending on the type of institution you work in.

This all harkens back to some of your critiques in the book. If HIV aid can be doled out differently, and actually help to build up health systems, then the problems we’re facing and the solutions we come up with in global health might look a lot different.

It could be. But to be clear, if we had 200 people with Ebola that we had to treat in in the US, I’m not sure how well we would do. And it’s not simply because we have a fragmented health system. It’s because the intensive care required to treat all of those people and have a high survival rate would be really time and labor intensive, and financially intensive. Making sure that all workers can do proper infection control and can protect themselves while administering treatment is important. We’ve faltered in that regard in some of our hospitals. I know someone who was treated for Ebola in the US. He says he had that around-the-clock care—pretty much that he had everything but the kitchen sink thrown at him to treat him. And he couldn’t have imagined that care in Monrovia, which is where he got sick. So, I wonder about whether we could handle that at a very large scale. The question is: would we have gotten to the point that the most affected countries got to? Probably not; we have minimized the spread here.

Certainly, it would have been helpful if public health systems had been functioning well early on in the epidemic. But that didn’t happen. In addition to health systems that provide treatment for illnesses, it means there also has to be a greater emphasis on actual public health functioning—the nitty-gritty of public health, which is really active surveillance. Grassroots surveillance. Health education and communications. Referral systems. But that all still requires something more than infrastructure and institutions. It also requires community trust in those systems to be able to work effectively.

]]>Oxfam America’s “Politics of Poverty”: Is Feed the Future leading to lasting improvements to global food security? Emmanuel Tumusiime, a researcher on economic justice and agriculture at Oxfam America, discusses Oxfam America’s new report analyzing the impact of the U.S. government’s Feed the Future initiative. The “framework of analysis emphasized four key themes: inclusiveness, empowerment,…More

]]>“Pharma giant Merck has become the latest drug company to shareintellectual property rights with a UN-backed patent pool for HIVmedicines, but critics have told SciDev.Net it is “a false solution to a real problem”.”

]]>http://www.globalhealthhub.org/2015/03/16/mercks-hiv-patent-agreement-ignites-monopoly-criticism/feed/0Placing women at the centre of the food systemhttp://www.globalhealthhub.org/2015/03/16/placing-women-at-the-centre-of-the-food-system/
http://www.globalhealthhub.org/2015/03/16/placing-women-at-the-centre-of-the-food-system/#commentsMon, 16 Mar 2015 15:27:45 +0000http://www.globalhealthhub.org/?p=145529Marc Van Ameringen | “Each year International Women’s Day shines a spotlight on women, putting them at the centre of development and equality efforts. For Read More

]]>Marc Van Ameringen | “Each year International Women’s Day shines a spotlight on women, putting them at the centre of development and equality efforts. For the nutrition community the numerous links between empowering women and improving nutrition are well understood. However, less clearly understood is how we can build food systems that put women and children at the centre.”

]]>http://www.globalhealthhub.org/2015/02/06/u-s-policies-interfere-with-womens-access-to-safe-abortions/feed/0U.S. Government Officials Weigh In On Measles Vaccination Debatehttp://www.globalhealthhub.org/2015/02/05/u-s-government-officials-weigh-in-on-measles-vaccination-debate/
http://www.globalhealthhub.org/2015/02/05/u-s-government-officials-weigh-in-on-measles-vaccination-debate/#commentsFri, 06 Feb 2015 01:25:00 +0000http://www.globalhealthhub.org/2015/02/05/u-s-government-officials-weigh-in-on-measles-vaccination-debate/NPR: CDC Director: ‘Unfortunately, I’m Not Surprised’ By Measles’ Rise “Robert Siegel talks to Tom Frieden, director of the Centers for Disease Control and Prevention, about the current measles outbreak in the U.S. and the government’s response…” (Siegel, 2/4). Washington Post: The politics of the vaccination debate In this video, “[t]he debate about mandated vaccinations…More

]]>NPR: CDC Director: ‘Unfortunately, I’m Not Surprised’ By Measles’ Rise “Robert Siegel talks to Tom Frieden, director of the Centers for Disease Control and Prevention, about the current measles outbreak in the U.S. and the government’s response…” (Siegel, 2/4). Washington Post: The politics of the vaccination debate In this video, “[t]he debate about mandated vaccinations…More

]]>http://www.globalhealthhub.org/2015/02/05/u-s-government-officials-weigh-in-on-measles-vaccination-debate/feed/0Is ketamine about to become inaccessible in low-income countries?http://www.globalhealthhub.org/2015/01/30/ketamine-become-inaccessible-low-income-countries/
http://www.globalhealthhub.org/2015/01/30/ketamine-become-inaccessible-low-income-countries/#commentsFri, 30 Jan 2015 20:38:51 +0000http://www.globalhealthhub.org/?p=143395A storm is brewing with the potential to create a global “public health crisis”, denying access to safe surgery and anesthesia for roughly a billion Read More

]]>A storm is brewing with the potential to create a global “public health crisis”, denying access to safe surgery and anesthesia for roughly a billion people in low-income countries. The issue at stake? Access to ketamine, the anesthetic of necessity in most low-income countries.

The Commission on Narcotic Drugs, the central drug policy-making body within the United Nations, has been asked to review a proposal to place ketamine in Schedule I under the Convention on Psychotropic Substances of 1971 (E/CN.7/2015/7). This move is being passed off as being as major victory for reducing illicit use, while the medical impacts are being underplayed: other countries (mainly high income countries) have placed ketamine under national control, and there have been no documented national public health crises in these countries. However, the reality for low-income countries is far from it, and there is little reason to suspect that ketamine, if placed under controls, is likely to be saved from a similar fate as other controlled medicines of poor access, restricted use, and being implicated in the unnecessary suffering of millions of people.

First, the proposal. China has requested that ketamine be placed in Schedule I of the Convention on Psychotropic Substances. Under the Convention, drugs in Schedule I are prohibited from being used except for “very limited medical purposes.” This is clearly an inappropriate characterization of a drug that is considered to be an essential medicine for both adults and children by the World Health Organization, and is widely used in low-income countries as a cheap, safe, and effective anesthetic and analgesic. Furthermore, esketamine (a slightly different version of ketamine), has shown promise for treatment-resistant depression with Johnson & Johnson currently running a phase 2 clinical trial of an intranasal version of the drug. In short, characterizing the drug as having very limited purposes is clearly inappropriate and inaccurate. Furthermore, placing it in the company of other Schedule I substances – LSD and PCP, for example – is outrageous.

Second, this places the Commission on Narcotic Drugs in yet another awkward position. To place a drug under international controls requires a review and recommendation by the World Health Organization through the Expert Committee on Drugs and Dependence (ECDD). The ECDD reviewed ketamine in 2014 (and previously in 2006) and both times has recommended against placing the drug under international controls. The reasons for this recommendation? First, there is limited evidence of harm associated with ketamine abuse, aside from lower urinary tract problems. Ketamine is a powerful dissociative drug, so clearly acute intoxication with the drug will produce psychological effects, but the long-term harms of use seem to be relatively confined to a subgroup of the population and not widespread. The drug is used and abused recreationally, and that is something that everyone – including the medical community and the ECDD – acknowledge and want to prevent; however, the ECDD clearly note that abuse and diversion of the drug are not so widespread as to constitute a public health crisis. That is to say, the risks of scheduling ketamine far outweigh its benefits.

This is far from a cautionary tale of drug policy gone astray; this is a recognition of the fact that that the international drug control system has likely created, and has certainly exacerbated, the greatest global health inequity in the world: an inability of people in pain to access analgesics that are both effective and affordable. And this is a problem that overwhelmingly affects the poor. Check out a graph from a manuscript my colleague and I published a few years ago in PLOS Medicine of the morphine that is theoretically available on a per capita basis around the world (I say theoretically, because this represents import quotas – the maximum allowable amount of morphine to be imported in each country per year – rather than actual consumption, which is likely much lower):

The differences are immediately noticeable, with not one low-income country being in the same ballpark as any of the high-income countries. We have known for years that access to analgesics is virtually non-existent for 80% of the world. Yet, the Commission on Narcotic Drugs is prepared to make the same mistakes over again.

]]>http://www.globalhealthhub.org/2015/01/30/ketamine-become-inaccessible-low-income-countries/feed/0Post-2015 Development Goals Must Be Realistic, Have Clear Rationalehttp://www.globalhealthhub.org/2015/01/09/post-2015-development-goals-must-be-realistic-have-clear-rationale/
http://www.globalhealthhub.org/2015/01/09/post-2015-development-goals-must-be-realistic-have-clear-rationale/#commentsFri, 09 Jan 2015 23:03:00 +0000http://www.globalhealthhub.org/2015/01/09/post-2015-development-goals-must-be-realistic-have-clear-rationale/The Guardian: Eight months until new development goals are agreed. Then what? Charles Kenny, senior fellow at the Center for Global Development and a Schwartz fellow at the New America Foundation “…The politics of writing the [Sustainable Development Goals] appears to have ensured the politics of using them has been relegated to a distant afterthought.…More

]]>The Guardian: Eight months until new development goals are agreed. Then what? Charles Kenny, senior fellow at the Center for Global Development and a Schwartz fellow at the New America Foundation “…The politics of writing the [Sustainable Development Goals] appears to have ensured the politics of using them has been relegated to a distant afterthought.…More

]]>http://www.globalhealthhub.org/2015/01/09/post-2015-development-goals-must-be-realistic-have-clear-rationale/feed/0License to Serve: US Trainees and the Ebola Epidemichttp://www.globalhealthhub.org/2014/12/18/license-serve-us-trainees-ebola-epidemic/
http://www.globalhealthhub.org/2014/12/18/license-serve-us-trainees-ebola-epidemic/#commentsThu, 18 Dec 2014 17:43:10 +0000http://www.globalhealthhub.org/?p=141425Before medical school, Sara L., now a fourth-year resident, worked for 6 years as a microbiologist at the Centers for Disease Control and Prevention. While Read More

Before medical school, Sara L., now a fourth-year resident, worked for 6 years as a microbiologist at the Centers for Disease Control and Prevention. While there, she focused on hemorrhagic fevers, and she went to West Africa several times to assist in outbreaks. Indeed, until recently, Sara was one of only a few hundred people in the United States who was trained to work in a biosafety level 4 “spacesuit” laboratory, which requires the same personal protective equipment (PPE) needed for working with Ebola. As the current Ebola epidemic exploded, and after careful deliberation, Sara sought and secured a position with an international aid organization, got approval from her residency program’s leadership, found coverage for her time away, and 6 weeks later, was set to deploy. Then she got a call from her institution’s risk-management department with disappointing news: the institution would not support her deployment.

At multiple U.S. academic medical centers (AMCs), well-qualified trainees and sometimes faculty members are facing similar obstacles to deployment.1,2 While much attention has been paid to readying AMCs to care for Ebola patients in the United States, there has been little discussion about the role they should play in international relief efforts. Absent a uniform policy for responding to deployment requests, AMCs are taking varying approaches, generally dealing with requests on a case-by-case basis; even within a given institution, one division may support deployment while another doesn’t. And the dynamic nature of the crisis in West Africa and the level of panic here at home create moving targets for any guidelines. Given that this is the largest public health crisis many of us will ever see and that the professed mission of AMCs is to advance the health of the population, what drives the apparent resistance?

One of the unique challenges of deployment is the requirement to spend 2 months away from one’s usual clinical work, necessitating that someone pick up the slack. Here, leadership can play a critical role: when two faculty members in Brown University’s emergency medicine division arranged to go work in West Africa, for instance, division chair Brian Zink sent out an e-mail message calling them “heroes” and asking others to “gift a shift” — and he was the first to sign up. The University of California, San Francisco, created a “vacation bank” where faculty donate paid vacation time, giving Ebola volunteers a cushion so they needn’t take unpaid leave; more than 2000 hours have been donated. In one pediatric infectious disease division, within an hour after e-mail went out asking people to pitch in, 2 months’ worth of shifts had been filled. Such altruism on the part of colleagues is reportedly widespread.

But even if volunteers can get others to pitch in, they may encounter an endless assortment of bureaucratic hurdles, any one of which can derail months of preparatory effort. As part of her global health fellowship, Heather S. had been planning to go to Liberia since March, but the title “fellow” was her undoing. Although she functions as an attending physician at her institution, 3 days before her planned departure, she was told that as a trainee she had to file for an exemption. Then that exemption was denied, so she had to take an unpaid leave of absence, without benefits.

Grace M., a second-year fellow in infectious disease who had similarly planned to spend 2 months doing international work, couldn’t make it past the graduate medical education office. Her institution’s policy against allowing trainees to care for patients with Ebola, she was told, meant that they couldn’t be approved for international deployment. If she went, she would have to take unpaid leave, which meant losing her health insurance coverage. For Grace, whose husband and 1-year-old daughter are on her health plan, that was the sticking point.

For Sara, it came down to the semantics of her “job description” and the difference between protected and nonprotected leave. Protected leaves are common: you have a baby or get sick, and your job is there for you when you get back. Nonprotected leave means there’s no such guarantee. The physician who oversaw Sara’s case explains the distinction as follows: “As a cardiologist, if you wanted to take your kids sailing around the world for a year, you’d have to take a nonprotected leave. They don’t hire you to sail around the world for a year.” And Sara, as she was told, wasn’t hired to respond to an Ebola outbreak.

Certainly most of our job descriptions fail to mention responding to an Ebola outbreak, but our institutions’ mission statements undoubtedly describe aims such as “relieving suffering” and “improving the health of the population.” Even if that population is defined in a geographically narrow way, the only sure way to protect Americans from Ebola is to stop the epidemic in West Africa.3Institutions that don’t want something to happen can always find a rule, or just a phrase within one, to prevent it from happening, but what’s motivating their unwillingness to depart from their rules in these circumstances?

Some concerns are trainee-specific. Many global health experts argue that a crisis is not the time for trainees to be on the front lines. Indeed, according to a recent statement published in Disaster Medicine and Public Health Preparedness, “Only those clinicians with the highest level of readiness — personal, mental, and professional — should consider deployment. Trainees, medical students, residents, and fellows must be strongly discouraged from volunteering.”4

AMCs have an obligation to protect their trainees; infection is the obvious risk in this case, but several people I spoke with also mentioned the potential for psychological trauma and post-traumatic stress disorder. In addition, there is an imperative to hold international health efforts to the same quality standards and rules that we follow at home. Sending a trainee into a crisis situation without oversight is unethical, I was told, like sending an intern to do C-sections alone. One physician argued that even with appropriate safeguards in place, allowing trainees to provide care in a crisis smacks of Tuskegee-era experimentation on poor minorities. Finally, there was some suggestion that trainees might not be able to understand what they were getting themselves into and might lack the maturity to handle it. For these reasons, an international risk manager explained to me, “You begin with the premise that no trainee should go. Then try to prove me wrong.”

Here’s how I would try. First, though donning and doffing PPE, the critical skills for infection control, undoubtedly require practice, they have nothing to do with years in practice. Second, concern about quality of care is real, but to dismiss all trainee relief efforts on that basis is to oversimplify and to undervalue the skill sets of many U.S. “trainees.” Of course we shouldn’t send interns to staff Ebola treatment units. But many trainees are licensed to practice, have extensive experience in international health, and are as technically skilled as they will ever be. Who would you rather have inserting your central line: a world-renowned scientist who attends on the wards 1 month a year — or a critical care fellow? Finally, yes, this crisis is unfathomable, but it is so to everyone, not just trainees; if we avoided all situations that we couldn’t understand in advance and that posed any risk, we would spend our lives in a state of paralysis.

Despite such arguments, however, if your job is risk management, Ebola deployments may well seem unmanageable. Mitigating one’s personal risk of contracting Ebola is not impossible, but where risk-management bodies exist to oversee deployments, asking them to grant permission is tantamount to asking them not to do their job. Especially in the face of widespread fear of the Ebola epidemic, decision makers focused on clearly serious risks may have a hard time seeing sufficient benefit in allowing workers to venture into the epicenter. “In the context of fear and risk regulation,” writes Cass Sunstein, “people will be closely attuned to the losses produced by any newly introduced risk, or by any aggravation of existing risks, but far less concerned with the benefits that are foregone as a result of regulation.”5 Moreover, from a bottom-line perspective, public fear is hard for an AMC to ignore: what happens to your knee replacements, your elective PCIs, your birthing centers, if the public gets word that a flock of your employees just returned from Liberia?

In this setting, we need to strike a balance between being appropriately cautious and being scared. As Patricia Henwood, an emergency physician from the University of Pennsylvania who just returned from Liberia and will soon go back, told me, “I respect the virus, but I don’t fear it.” Such a distinction is as relevant to our approach to those seeking to control the virus as it is to the virus itself.

This Ebola epidemic is unlike any previous humanitarian crisis. But although the specific nature of the crisis lacks precedent, caring for people in need and teaching others to do so have long defined medicine’s professional ethic. As we intensify our efforts to define and document our professionalism, in milestones, check-boxes, and mission statements, I sometimes wonder if we move further away from knowing what it actually means. We should celebrate, not obstruct, the many physicians who have stepped up to remind us.

]]>http://www.globalhealthhub.org/2014/12/18/license-serve-us-trainees-ebola-epidemic/feed/02014: Year of the Social Determinants of Health?http://www.globalhealthhub.org/2014/12/18/2014-year-social-determinants-health/
http://www.globalhealthhub.org/2014/12/18/2014-year-social-determinants-health/#commentsThu, 18 Dec 2014 14:30:10 +0000http://www.globalhealthhub.org/?p=141402As I reflect on the major events of 2014, I’m surprised by the underlying themes of social inequality and a global desire to do things better. Read More

]]>As I reflect on the major events of 2014, I’m surprised by the underlying themes of social inequality and a global desire to do things better. As a public health practitioner and soon-to-be minted medical doctor, I’m constantly considering the ways in which these events lend insight into the social determinants of health.

There are at least three themes that caught my interest, which I wish to reflect on here: Ebola, racial & LGBT inequality, and violence against women & children. I’ve included useful links in case you’d like to read more about particular stories.

My discussions with one medical volunteer, who recently returned from Liberia, unveiled the tremendous influence of post-colonialism on this modern-day event. With the slave trade originating in West Africa, the effects of colonial rule continue to impact the region. Interestingly, current epidemiological measurements suggest that the ongoing Ebola outbreak is subsiding in Liberia while persisting in Sierra Leone and Guinea. Liberia has colonial roots with the United States, benefitting from strong coordination with the CDC and other critical US agencies. Sierra Leone, on the other hand, is rooted in British rule while Guinea with the French. As of October 28, 2014 (per the
Guardian Ebola funding tracker), the US government delivered $575 million while the UK and France delivered just $222
million and $108 million respectively (though each country has smaller populations). Allocations for September were $473 million for Liberia, $220 million for Sierra Leone, and $57 million of Guinea. These relationships would appear to at least partially explain why the Liberian outbreak, though initially the worst, has experienced the most significant gains.

Social determinants were also exposed in the United States, where Liberian citizen Thomas Duncan was the first to be diagnosed with Ebola and ultimately succumbed to the disease. Multiple questions were raised from his death: Why was he initially turned away from care? Why did he die and others with Ebola in the US survive? The cynics among us would point out the ugly realities: Thomas Duncan was a person of color, uninsured, and foreign. Further unsettling is the other death in the United States: US resident and Sierra Leone native, Dr. Martin Salia. Though both Salia and Duncan’s deaths were ultimately due to delays in care and the high viral load they were exposed to, one wonders if their fate would be different if they were white and socially connected?

Racial and LGBT Inequality

This year, decades of post-civil rights era racial inequality came to a head through the high-profile killings of young, African American men by white police officers in Ferguson, Staten Island, and Cleveland. The #BlackLivesMatter campaign and country-wide protests shed light not only on specific instances of racial discrimination but also on the systematic exclusion of people of color throughout our societies.

These troubling events highlight key disparities in race and sexual orientation. Though we shouldn’t forget areas of important progress, we must remember the tremendous gap in social equity and its detrimental health consequences. The life expectancy for blacks in the US, for example, is 30 years behind that of whites. Despite recent advances in US legislation, LGBT communities continue to face higher burdens of chronic disease and mental illness, while often receive substandard medical care.

The nexus for much of the violence surrounds the deeply held belief by some factions that women should not participate in education. Yet, we know that some of the most profitable social investments (including tremendous health yields) may be achieved if educate our children and empower our women. So much so, in fact, that donors, such as the Gates Foundation, have made this a pillar of global development. Thankfully, this trend appears to be growing and will likely continue to remain a key component of the UN’s 2015 Sustainable Development Goals.

2015 and Beyond

As we look forward to a new year, may we continue to reflect on events that lend insight into upstream influences of health and well being. Moreover, let’s strive for social change that truly transforms lives and advances health equity for all.

Despite many seemingly negative stories reflecting our shortcomings, we should also remember the victories. Bill Gates, for example, now writes an annual “Good News You May Have Missed…” blog. These successes should inspire us to be better as individuals, communities, and societies, ultimately being “the change [we] wish to see in the world.”

]]>http://www.globalhealthhub.org/2014/12/18/2014-year-social-determinants-health/feed/0Stunthttp://www.globalhealthhub.org/2014/12/16/stunt/
http://www.globalhealthhub.org/2014/12/16/stunt/#commentsTue, 16 Dec 2014 14:28:00 +0000http://www.globalhealthhub.org/2014/12/16/stunt/I mean, you have to wonder what UNICEF was thinking. For those so far out in the field that they have poor internet, and/or are otherwise simply too busy to click the link, here’s summary, courtesy of Al Jazeera: In an attempt to raise awareness of the conflict in South Sudan, UNICEF traveled to a […]

I mean, you have to wonder what UNICEF was thinking. For those so far out in the field that they have poor internet, and/or are otherwise simply too busy to click the link, here’s summary, courtesy of Al Jazeera: In an attempt to raise awareness of the conflict in South Sudan, UNICEF traveled to a […]